Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Race to Health Info Tech--Tortoise or Hare?

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"Providers Believe Healthcare Reform will Increase Their Costs."  Here follow a few of its responses: 61% believe "electronic health records (EHRs) could have a positive impact on their businesses" 82% cited their biggest challenge in implementing HlT is cost. 17% of providers are or are planning to participate in a Health Information Exchange (HIE) over the next 12 months. 

Incentives That Can Make or Break Reform

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Our health care system is particularly inefficient and, for some, inaccessible.  As for the quality of care, by any measure it is variable at best.  Why is it so hard to fix?  Why do we pale in relation to most of the industrialized world?

Adequate Coverage?

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Wal-Mart Stores, Inc., the world's largest retailer, is in favor of President Obama's initiative—to mandate that large employers offer health insurance to workers and their families. But, isn't this is the same company who is accused of "mistreating employees and not offering adequate healthcare coverage"? Why would they endorse reform? Follow the $$$$

Saying No, Well

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Clearly, not fulfilling patients' requests diminishes their satisfaction, but patient-centered communication can enhance that. So what is one to do? Being adept at saying "no" is an art; it should preserve, if not amplify a practitioners' interest in and concern for their patient. This article describes ways of negotiating with patients about specific requests for diagnostic testing, treatment, on-going or changing care.

As the Care Improves, So Does the Cost

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To those of us in primary care and our patients, chronic diseases are insidiously costly to body, soul and pocketbook. And, watching a patient with an otherwise manageable illness develop complications that are avoidable or that can be delayed is entirely pathetic. "Not only is this a tragedy for the patient, but it is also a tragedy for our healthcare system as a whole. The actual monetary costs of the sequelae of diabetes are astronomical.

The Way of Malpractice

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Getting sued for malpractice can make any practitioner overly practice defensively, which is not the same as more effectively and certainly not more cost-effectively.  Abstract "Despite widespread agreement that physicians who practice defensive medicine drive up health care costs, the extent to which defensive medicine increases costs is unclear. The differences in findings to date stem in part from the use of two distinct approaches for assessing physicians' perceived malpractice risk.

Dysfunctional Liability System

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See Defensive medicine has been highlighted as a major driver of health care costs here and elsewhere.  It probably is when you consider the indirect costs (how it changes the way we practice).   Along comes the Accountable Care Organization Are ACOs Subject to More or Less Liability? Yes, and it is instructive to review why and how they are different.

Managed Care Organizations Practicing Medicine (Without a License)

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Aetna refused to pay for a visit of a child with a probable goiter and strong family history who needed diagnostic lab tests—they do not accept rule-outs.  Not long ago, Oxford levied a $50 deductible and $25 co-pay for the most efficacious eardrop we have in our armamentarium; Reason? This drop, containing an antibiotic and a steroid was not available generically; they were forcing me to use a plain ear drop – not what the doctor ordered! Mental Health Parity; Let the HMO's Be Damned!

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